Characterization and treatment of biliary anastomotic stricture after segmental liver transplantation

Background/Purpose: Biliary anastomotic strictures (BAS) after left lateral segment liver transplantation (LLST) may cause graft dysfunction, sepsis, and patient mortality. A review of the authors' experience was performed to better characterize the risk factors and corrective management. Methods: The medical records of 9 children who underwent a LLST in whom a B AS developed from 1989 to the present were reviewed retrospectively. Results: Seventy-five of 199 liver transplants (38%) at the authors' instit ution since 1989 have been LLST. BAS developed in 12% of these cases. BAS w ere diagnosed less than 12 months after transplantation in 4 children (mean , 7.5 months; range, 5 to 11 months) and greater than 12 months in 5 childr en (mean, 37 months; range, 14 to 72 months). Early strictures (<12 months) were associated with hepatic artery thrombosis (n = 1), and posttransplant bile leak (n = 1) and ducts from segment II and III exiting separately fro m the left lateral segment (n = 2). The diagnosis of BAS was heralded by ep isodes of liver biopsy-proven cholangitis in all patients and confirmed rad iographically. Seven children underwent successful biliary exploration and revision of the hepaticojejunostomy. Two of these children ultimately requi red retransplantation secondary to chronic graft rejection. Conclusions: BAS in LLST are a source of significant morbidity and should b e considered in children after LLST who present with cholangitis. Surgical correction is possible in most cases. Copyright (C) 2000 by W.B. Saunders C ompany.